| PLEASE TYPE Name______________________________________ Date____________________ Last First Middle Home Address_______________________________________ Soc. Sec. No._______________ Street______________________________________________ Phone___________________________ _____________________________ (Home) (Office) Office or School Address_______________________________ Date of Birth_______________ Street______________________________________________ City, State, Zip__________________________________________________ Mailing Preference (Circle one) Home Office | DATE WORK HISTORY: FULL TIME ONLY | FROM (YEAR) | TO (YEAR) | CHURCH/EMPLOYER | CITY, STATE | TITLE/TYPE OF WORK | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | DATE WORK HISTORY: RELEVANT PART-TIME OR VOLUNTEER (Do not include service to the church) | FROM (YEAR) | TO (YEAR) | CHURCH/EMPLOYER | CITY, STATE | HRS PER WK/MO | TITLE/TYPE OF WORK | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | DATE SERVICE TO THE CHURCH | FROM (YEAR) | TO (YEAR) | CHURCH/EMPLOYER | CITY, STATE | HRS PER WK/MO | TITLE/TYPE OF WORK | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | DATES ATTENDED FORMAL EDUCATION | FROM (YEAR) | TO (YEAR) | COLLEGE, UNIVERSITY THEOLOGICAL SEMINARY | CITY, STATE | DEGREE/ DIPLOMA | SPECIALIZATION | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Successful completion of the degrees above must be verified. Please include with your application a letter from each college, university or theological seminary on its stationery and with its stamp or seal documenting degrees listed above. OTHER PROFESSIONAL OR TECHNICAL CERTIFICATION OR ACCREDITATION ECCLESIASTICAL STATUS (Please check and fill in as appropriate): Local Church Membership:_____________________________________________________ Mailing Address:_____________________________________________________________ Presbytery ___________________________Synod__________________________________ [ ] Ordained Minister, Date Ordained ________________ Presbytery Membership ____________________ REFERENCES (List 4-6 persons who are in a position to give an objective evaluation of your training, experience and capabilities. This list must include your present minister and a minister or elder of your most recent previous position if you have served your present church less than five years.) | NAME | COMPLETE ADDRESS | PHONE (include Area Code) | | | | | | | | | | | | | | | | | | | | | | | | | I hereby authorize those inquiring into my suitability for accreditation to make inquiry of the above listed persons. Date ______________________ Signature__________________________________________________
| All Certification forms need to be mailed to the PAM National Office: Presbyterian Association of Musicians 100 Witherspoon Avenue Louisville, KY 40202-1396 For questions please call the PAM National Office at 502-569-5288 (toll free) 1-888-728-7228 xt. 5288 | |
Revised 11/2002 |